Basic Information
| Provider Information | |||||||||
| NPI: | 1871905547 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RIVERA | ||||||||
| FirstName: | ANTHONY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1840 S BEVERLY GLEN BLVD APT 305 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900256928 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4247770286 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8655 HAVEN AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | RANCHO CUCAMONGA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917304891 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8006425031 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/28/2014 | ||||||||
| LastUpdateDate: | 05/28/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 064769-1 | NY | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.